Ballenger, Fred Jackson

Ballenger, Fred Jackson is an individual health care provider with primary practice located at 2602 Franklin Rd Sw , Roanoke VA 24014-1010. He recently has only one registered license in Allopathic & Osteopathic Physicians / Nephrology, which is considered as his primary health care specialty. Ballenger, Fred Jackson can be contacted via phone (540) 344-1400.

Contact Information

Primary practice address
2602 Franklin Rd Sw Roanoke VA 24014-1010
Fax: (540) 344-7133
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Nephrology 207RN0300X 0101027649 Virginia

Profile Details

NPI number 1447258728
LBN Legal business name Ballenger, Fred Jackson
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 12th, 2005
Last updated Mar 29th, 2021 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1447258728 NPPES
Virginia MEDICAID 6091270
Virginia Other CG1162

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